Underevaluated and ineffective, but now government policy

American psychiatrists visiting Britain will experience a sense of deja vu when they encounter the recent clutch of community care “initiatives.” They will soon spot that “care management” and the “care programme approach” are no more than a rehash of “case management,” an old American idea. From politeness they will probably refrain from telling their hosts that there is little reason to believe that case management works.

Case management arose in the United States in response to the dispersal of psychiatric and social care that followed the closure of large mental hospitals. The basic idea was that a designated person, the “case manager,” would take special responsibility for a “client” in the community. The case manager would assess the client's needs and ensure, through a care plan, that suitable services were provided to meet them. The case manager would also monitor the provision of these services and maintain contact with the client.1

From the beginning the literature on “case management” has been bedevilled by a tendency to …